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DSH230017D BRONSON METHODIST HOSPITAL (Terminated)
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Main Details
Name
BRONSON METHODIST HOSPITAL
Subdivision Name
Bronson Vicksburg Outpatient Center
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH230017D
Medicare Provider Number
230017
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
8/31/2012
Participating Start Date
10/1/2012
Participating Approval Date
9/18/2012
Last Recertification Date
8/20/2015
Termination Date
Termination Reason
4/1/2016
Site closure
Contacts
Authorizing Official
Bronson Healthcare Group
James B. Falahee Jr., Sr. Vice President, Legal & Legislative Affairs
(269) 341-8907
Primary Contact
Bronson
Shaun Phillips, Vice President, Clinical and Pharmacy Services
(269) 245-5987
Addresses
Street Address
13326 N. Boulevard Street
Vicksburg, MI 49097
Billing Address
Bronson Accounts Payable
PO Box 4001
Kalamazoo, MI 49003-4001
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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